论曰。夫风者。百病之始也。清净则腠理闭拒。虽有大风苛毒。而弗能为害也。故破伤风者。通于表里。
分别阴阳。同伤寒证治。闾阎往往有不知者。只知有发表者。不知有攻里者和解者。此汗下和三法也。亦同伤
寒证。有在表者。有在里者。有半在表半在里者。在里宜下。在表宜发汗。在表里之间宜和解。然汗下亦不可
过其法也。又不可妄意处治。各通其脏腑。免汗泄之非宜也。故破伤风者。从外至内甚于内者。则病也。因此
卒暴伤损风袭之间。传播经络。至使寒热更作。身体反强。口噤不开。甚者邪气入脏。则分汗下之治。诸疮不
瘥。荣卫虚。肌肉不
生。疮眼不合者。风邪亦能外入于疮。为破伤风之候。故诸疮不瘥时。举世皆言着灸为上。是谓熟疮。而不知
火热客毒逐经诸变。不可胜数。微则发热。甚则生风而搐。或角弓反张。口噤目邪。皆因疮郁结于荣卫。不得
宣通而生。亦有破伤不灸而病此者。疮着白痂。疮口闭塞。气难通泄。故阳热易为郁结。而热甚则生风也。
故表脉浮而无力。太阳也。脉长而有力者。阳明也。脉浮而弦小者。少阳也。太阳宜汗。阳明宜下。少阳宜和。
若明此三法。而治不中病者。未之有也。
羌活防风汤 治破伤风邪。初传在表。
羌活 防风 川芎 本 当归 芍药 甘草（各一两） 地榆 华细辛（各二两）
上 咀。每服五七钱。水一盏半。同煎至七分。去滓热服。不拘时候。量紧慢加减用之。热则加大黄二两。
大便秘。则加大黄一两。缓缓令过。
白术防风汤 若服前表药过。有自汗者。宜服此药。
白术（一两） 防风（二两） 黄 （一两）
上 咀。每服五七钱。水一盏半。煎至一盏。去滓温服。不拘时候。
脏腑和而有自汗。可用此药。
破伤风脏腑秘。小便赤。自汗不止者。因用热药。汗出不休。故知无寒也。宜速下之。先用芎黄汤。三二
服后。用大芎黄汤下之。
芎黄汤
川芎（一两） 黄芩（六钱） 甘草（二钱）
上 咀。每服五七钱。水一盏半。同煎至七分。去渣温服。不拘时候。三服即止。再用下药。
大芎黄汤
川芎（二两） 羌活 黄芩 大黄（各一两）
上 咀。根据前煎服。宜利为度。
发表雄黄散
雄黄（一钱） 防风（二钱） 草乌（一钱）
上件为细末。每服一字。温酒调下。里和至愈可服。里不和不可服。
蜈蚣散
蜈蚣（一对） 鳔（五钱） 左蟠龙（五钱炒烟尽为度野鸽粪是也）
上件为细末。每服一钱。清酒调下。治法根据前用。里和至愈可服。但有里证不可服。次当下之。用前蜈蚣
散四钱。烧饭为丸。如绿豆大。每服一丸。渐加六七丸。清酒调蜈蚣少许送下。宣利为度。内外风去。可常服
羌活汤。缓缓而治。不拘时候服之。羌活汤者。治半在表半在里也。
羌活汤
羌活 菊花 麻黄 川芎 防风 石膏 前胡 黄芩 细辛 甘草 枳壳 白茯苓 蔓荆子（各一两）
薄荷（半两） 吴白芷（半两）
上 咀。每服五钱。水一盏半。入生姜五片。同煎至一盏。去渣稍热服。不拘时候。日进二服。
防风汤 治破伤风同伤寒表证。未解入里。宜急服此药。
防风 羌活 独活 川芎（各等分）
上 咀。每服五钱。水一盏半。煎至七分。去滓温服。二三服后。宜调蜈蚣散。大效。
蜈蚣散
蜈蚣（一对） 鳔（三钱）
上为细末。用防风汤调下。如前药解表不已。觉转入里。当服左龙丸微利。看大便硬软。加巴豆霜服之。
左龙丸
左蟠龙（五钱炒） 白僵蚕 鳔（各五钱炒） 雄黄（一钱）
上同为细末。烧饼为丸。如桐子大。每服十五丸。温酒下。如里证不已。当于左龙丸末一半内。入巴豆霜
半钱。烧饼为丸。如桐子大。每服一丸。同左龙丸一处合服。每服药中加一丸。如此渐加服至利为度。若利
后更服后药。若搐 不已。亦宜服后药羌活汤也。
羌活汤
羌活 独活 防风 地榆（各一两）
上 咀。每服五钱。水一盏半。煎至一盏。去滓温服。如有热加黄芩。有涎加半夏。若病日久。气血渐虚。
邪气入胃。宜养血为度。
养血当归地黄散
当归 地黄 芍药 川芎 本 防风 白芷（各一两） 细辛（五钱）
上 咀。根据前煎服。
雄黄散 治表药。
天南星（三钱） 半夏 天麻（各五钱） 雄黄（二钱半）
上为细末。每服一钱。温酒调下。如有涎。于此药中加大黄为下药。
地榆防风散 治破伤中风。半在表。半在里。头微汗。身无汗。不可发汗。宜表里治之。
地榆 防风 地丁香 马齿苋（各等分）
上件为细末。每服三钱。温米饮调下。
白术汤 治破伤风。大汗不止。筋挛搐搦。
白术 葛根（各一两） 升麻 黄芩（各半两） 芍药（二两） 甘草（二钱半）
上 咀。每服一两。水一盏半。煎至一盏。去滓温服。不拘时候。
江鳔丸 治破伤风。惊而发搐。脏腑秘涩。知病在里。可用江鳔丸下之。
江鳔（半两 炒） 野鸽粪（半两炒） 雄黄（一钱） 白僵蚕（半两） 蜈蚣（一对） 天麻（一两）
上件为细末。又将药末作二分用。一分烧饼为丸。如桐子大。朱砂为衣。后一分入巴豆霜一钱同和。亦以
烧饼为丸。如桐子大。不用朱砂为衣。每服朱砂为衣者二十丸。入巴豆霜者一丸。第二服二丸。加至利为度。
再服朱砂为衣药。病愈止。
没药散 治刀箭所伤。止血定痛。
定粉（一两） 风化灰（一两） 枯白矾（三钱另研） 乳香（半钱另研） 没药（一字另研）
上件各研为细末。同和匀再研掺之。
Commentary states: Wind is the beginning of all diseases. If the body remains pure and quiet (with sufficient righteous qi), the cou li (skin texture and pores) will close to resist external pathogens; even in the face of violent winds and severe toxins, harm cannot be caused. Therefore, tetanus (Po Shang Feng) involves pathogens penetrating both the exterior and interior.
One must distinguish between Yin and Yang; its syndrome treatment is similar to that of Cold Damage (Shang Han). Common people often lack understanding, knowing only methods for releasing the exterior (fa biao), but unaware of methods for purging the interior (gong li) or harmonizing the half-exterior half-interior (he jie). These are the three methods of sweating, purging, and harmonizing. This parallels Cold Damage syndromes, which can be located in the exterior, in the interior, or halfway between the two. For pathology in the interior, purging is indicated; for pathology in the exterior, sweating is indicated; for pathology halfway between the exterior and interior, harmonizing is indicated. However, sweating and purging must not exceed standard protocols. One must not treat arbitrarily but should regulate according to the Zang-Fu organs to avoid inappropriate sweating and depletion. Thus, tetanus originates from the exterior entering the interior; when it is more severe internally than externally, it constitutes disease. Following sudden trauma and wind invasion, the pathogen spreads through the meridians, causing alternating chills and fever, opisthotonos (body arching backward), trismus (lockjaw), and inability to open the mouth. In severe cases, the pathogen enters the Zang organs, requiring differentiation between sweating and purging treatments.
For various sores that fail to heal due to deficiency of Ying and Wei (nutritive and defensive qi), with muscle regeneration failure and non-closing wound margins, wind pathogens can also enter externally through the sore, manifesting as tetanus. Hence, when sores persistently fail to heal, the world generally advocates moxibustion as the superior method, termed "ripened sore" (Shu Chuang). However, people are unaware that heat-fire pathogens residing within become toxic and produce countless variations along the meridians. Mildly, this presents as fever; severely, it generates wind leading to convulsions, opisthotonos, trismus, and strabismus. These arise because the sore causes stagnation within the Ying and Wei, preventing free circulation. There are also cases where tetanus occurs after injury without moxibustion. The sore is covered by a white scab, the wound margin is closed, and Qi diffusion is obstructed, allowing Yang-heat to easily stagnate; excessive heat then generates wind.
Therefore, a floating but weak pulse indicates Taiyang syndrome; a long and forceful pulse indicates Yangming syndrome; a floating, wiry, and small pulse indicates Shaoyang syndrome. Taiyang syndrome is treated with sweating; Yangming syndrome with purging; Shaoyang syndrome with harmonizing. If these three methods are understood, there has never been a case where treatment fails to hit the mark.
Qiang Huo Fang Feng Tang (Notopterygium and Saposhnikovia Decoction): Treats tetanus pathogen initially transmitting to the exterior.
Ingredients: Qiang Huo (Notopterygii Rhizoma et Radix), Fang Feng (Saposhnikoviae Radix), Chuan Xiong (Ligustici Chuanxiong Rhizoma), Ben Cao (Ligustici Rhizoma), Dang Gui (Angelicae Sinensis Radix), Shao Yao (Paeoniae Radix), Gan Cao (Glycyrrhizae Radix et Rhizoma) [each 1 liang]; Di Yu (Sanguisorbae Radix), Hua Xi Xin (Asari Radix et Rhizoma) [each 2 liang].
Preparation and Administration: Coarsely crush the herbs. Take 5–7 qian per dose, add 1.5 zhan of water, decoct until 0.7 zhan remains, remove dregs, and take hot. Time is unrestricted; adjust dosage based on urgency. If heat signs are present, add Da Huang (Rhei Radix et Rhizoma) 2 liang; if constipation exists, add Da Huang 1 liang to gently induce bowel movement.
Bai Zhu Fang Feng Tang (Atractylodis Macrocephalae and Saposhnikovia Decoction): If spontaneous sweating occurs after taking previous exterior-releasing medicines, this formula is suitable.
Ingredients: Bai Zhu (Atractylodis Macrocephalae Rhizoma) [1 liang], Fang Feng (Saposhnikoviae Radix) [2 liang], Huang Qi (Astragali Radix) [1 liang].
Preparation and Administration: Coarsely crush. Take 5–7 qian per dose, add 1.5 zhan of water, decoct until 1 zhan remains, remove dregs, and take warm. Time is unrestricted. Suitable for patients with harmonized Zang-Fu presenting with spontaneous sweating.
If tetanus patients have internal constipation, red urine, and persistent spontaneous sweating due to prior use of hot medicines causing continuous sweating, it indicates absence of cold pathogens. Rapid purging is indicated. First use Xiong Huang Tang (Corydalis and Scutellaria Decoction); after 2–3 doses, follow with Da Xiong Huang Tang (Major Corydalis and Scutellaria Decoction).
Xiong Huang Tang:
Ingredients: Chuan Xiong (Ligustici Chuanxiong Rhizoma) [1 liang], Huang Qin (Scutellariae Radix) [6 qian], Gan Cao (Glycyrrhizae Radix et Rhizoma) [2 qian].
Preparation and Administration: Coarsely crush. Take 5–7 qian per dose, add 1.5 zhan of water, decoct until 0.7 zhan remains, remove dregs, and take warm. Time is unrestricted. Stop after 3 doses, then proceed with purging agents.
Da Xiong Huang Tang:
Ingredients: Chuan Xiong (Ligustici Chuanxiong Rhizoma) [2 liang], Qiang Huo (Notopterygii Rhizoma et Radix), Huang Qin (Scutellariae Radix), Da Huang (Rhei Radix et Rhizoma) [each 1 liang].
Preparation and Administration: Decoct and administer as previously described. Aim for unobstructed bowel movements.
Fa Biao Xiong Huang San (Exterior-Releasing Realgar Powder):
Ingredients: Xiong Huang (Realgar) [1 qian], Fang Feng (Saposhnikoviae Radix) [2 qian], Cao Wu (Aconiti Radix Preparata) [1 qian].
Preparation and Administration: Grind into fine powder. Take one "zi" measure, mixed with warm wine. Can be taken once the interior is harmonized until recovery. Do not take if the interior is disharmonious.
Wu Gong San (Centipede Powder):
Ingredients: Wu Gong (Scolopendra), Biao Jiao (Colla Corii Asini), Zuo Pan Long (Columbae Feces, stir-fried until smoke ceases) [each 5 qian].
Preparation and Administration: Grind into fine powder. Take 1 qian, mixed with clear wine. Treatment follows previous methods. Can be taken once the interior is harmonized until recovery. Contraindicated if interior excess syndrome is present; purging should follow. Use 4 qian of the above Centipede Powder, mix with cooked rice paste to form pills the size of mung beans. Take 1 pill initially, gradually increasing to 6–7 pills, taken with clear wine mixed with a little Centipede powder. Aim for bowel movement. Once internal and external wind pathogens are expelled, Chang Fu Qiang Huo Tang (Notopterygium Decoction) can be taken regularly for gradual treatment, time unrestricted. Qiang Huo Tang treats pathology halfway between the exterior and interior.
Qiang Huo Tang:
Ingredients: Qiang Huo (Notopterygii Rhizoma et Radix), Ju Hua (Chrysanthemi Flos), Ma Huang (Ephedrae Herba), Chuan Xiong (Ligustici Chuanxiong Rhizoma), Fang Feng (Saposhnikoviae Radix), Shi Gao (Gypsum Fibrosum), Qian Hu (Peucedani Radix), Huang Qin (Scutellariae Radix), Xi Xin (Asari Radix et Rhizoma), Gan Cao (Glycyrrhizae Radix et Rhizoma), Zhi Ke (Aurantii Fructus), Bai Fu Ling (Poria), Man Jing Zi (Vittariae Spora), Bo He (Menthae Haplocalycis Herba) [0.5 liang], Wu Bai Zhi (Angelicae Dahuricae Radix) [0.5 liang] [all others 1 liang].
Preparation and Administration: Coarsely crush. Take 5 qian per dose, add 1.5 zhan of water and 5 slices of Sheng Jiang (Zingiberis Rhizoma Recens), decoct until 1 zhan remains, remove dregs, and take slightly warm. Time is unrestricted. Take twice daily.
Fang Feng Tang: Treats tetanus resembling exterior syndrome of Cold Damage that has not resolved and is entering the interior; urgent administration is required.
Ingredients: Fang Feng (Saposhnikoviae Radix), Qiang Huo (Notopterygii Rhizoma et Radix), Du Huo (Angelicae Pubescentis Radix), Chuan Xiong (Ligustici Chuanxiong Rhizoma) [equal parts].
Preparation and Administration: Coarsely crush. Take 5 qian per dose, add 1.5 zhan of water, decoct until 0.7 zhan remains, remove dregs, and take warm. After 2–3 doses, it is advisable to combine with Wu Gong San for significant effect.
Wu Gong San:
Ingredients: Wu Gong (Scolopendra), Biao Jiao (Colla Corii Asini) [3 qian].
Preparation and Administration: Grind into fine powder. Mix with Fang Feng Tang for administration. If previous exterior-releasing medicines fail to resolve the exterior and symptoms suggest transition to the interior, take Zuo Long Wan (Left-Coiling Pill) to induce mild laxation. Adjust Ba Dou Shuang (Croton Seed Frost) dosage based on stool consistency.
Zuo Long Wan:
Ingredients: Zuo Pan Long (Columbae Feces, stir-fried) [5 qian], Bai Jiang Can (Bombyx Batryticatus), Biao Jiao (Colla Corii Asini, stir-fried) [each 5 qian], Xiong Huang (Realgar) [1 qian].
Preparation and Administration: Grind together into fine powder, form pills with roasted wheat cake dough, size of Sophora japonica seeds. Take 15 pills with warm wine. If interior syndrome persists, mix half of the Zuo Long Wan powder with 0.5 qian of Ba Dou Shuang, form pills with roasted wheat cake dough, size of Sophora japonica seeds. Take 1 pill combined with Zuo Long Wan. Increase by one pill per dose gradually until laxation occurs. If diarrhea continues, subsequent medications may be needed. If convulsions persist, the subsequent Qiang Huo Tang is also appropriate.
Qiang Huo Tang:
Ingredients: Qiang Huo (Notopterygii Rhizoma et Radix), Du Huo (Angelicae Pubescentis Radix), Fang Feng (Saposhnikoviae Radix), Di Yu (Sanguisorbae Radix) [each 1 liang].
Preparation and Administration: Coarsely crush. Take 5 qian per dose, add 1.5 zhan of water, decoct until 1 zhan remains, remove dregs, and take warm. Add Huang Qin (Scutellariae Radix) if heat is present; add Ban Xia (Pinelliae Rhizoma) if phlegm-saliva is present. If the disease duration is long and Qi-Blood are gradually deficient with pathogen entering the Stomach, nourishing Blood is the goal.
Yang Xue Dang Gui Di Huang San (Blood-Nourishing Angelica and Rehmannia Decoction):
Ingredients: Dang Gui (Angelicae Sinensis Radix), Di Huang (Rehmanniae Radix), Shao Yao (Paeoniae Radix), Chuan Xiong (Ligustici Chuanxiong Rhizoma), Ben Cao (Ligustici Rhizoma), Fang Feng (Saposhnikoviae Radix), Bai Zhi (Angelicae Dahuricae Radix) [each 1 liang], Xi Xin (Asari Radix et Rhizoma) [5 qian].
Preparation and Administration: Decoct and administer as previously described.
Xiong Huang San: Treats exterior syndrome.
Ingredients: Tian Nan Xing (Arisaematis Rhizoma Preparatum) [3 qian], Ban Xia (Pinelliae Rhizoma), Tian Ma (Gastrodiae Rhizoma) [each 5 qian], Xiong Huang (Realgar) [2.5 qian].
Preparation and Administration: Grind into fine powder. Take 1 qian, mixed with warm wine. If phlegm-saliva is present, add Da Huang (Rhei Radix et Rhizoma) as a purging agent.
Di Yu Fang Feng San: Treats tetanus stroke, pathology halfway between exterior and interior, slight head sweating, no body sweating; sweating method is contraindicated. Exterior and interior should be treated simultaneously.
Ingredients: Di Yu (Sanguisorbae Radix), Fang Feng (Saposhnikoviae Radix), Di Ding Xiang (Costi Folium), Ma Chi Xian (Portulacae Herba) [equal parts].
Preparation and Administration: Grind into fine powder. Take 3 qian, mixed with warm rice drink.
Bai Zhu Tang: Treats tetanus with profuse continuous sweating, tendon spasms, and convulsions.
Ingredients: Bai Zhu (Atractylodis Macrocephalae Rhizoma), Ge Gen (Puerariae Lobatae Radix) [each 1 liang], Sheng Ma (Cimicifugae Rhizoma), Huang Qin (Scutellariae Radix) [each 0.5 liang], Shao Yao (Paeoniae Radix) [2 liang], Gan Cao (Glycyrrhizae Radix et Rhizoma) [2.5 qian].
Preparation and Administration: Coarsely crush. Take 1 liang per dose, add 1.5 zhan of water, decoct until 1 zhan remains, remove dregs, and take warm. Time is unrestricted.
Jiang Biao Wan: Treats tetanus with fright-induced convulsions, internal constipation, indicating pathology in the interior; Jiang Biao Wan can be used for purging.
Ingredients: Jiang Biao (Jellyfish Membrane, stir-fried) [0.5 liang], Ye Ge Fen (Wild Pigeon Feces, stir-fried) [0.5 liang], Xiong Huang (Realgar) [1 qian], Bai Jiang Can (Bombyx Batryticatus) [0.5 liang], Wu Gong (Scolopendra) [1 pair], Tian Ma (Gastrodiae Rhizoma) [1 liang].
Preparation and Administration: Grind into fine powder. Divide the powder into two portions. One portion forms pills with roasted wheat cake dough, size of Sophora japonica seeds, coated with Cinnabar (Zhusha). The other portion is mixed with 1 qian of Ba Dou Shuang (Croton Seed Frost), formed into pills with roasted wheat cake dough, size of Sophora japonica seeds, without Cinnabar coating. Take 20 Cinnabar-coated pills and 1 Ba Dou Shuang pill per dose. Second dose: increase Ba Dou Shuang pill to 2. Continue increasing until laxation occurs. Resume taking Cinnabar-coated pills until recovery.
Mo Yao San: Treats knife and arrow wounds, stops bleeding and relieves pain.
Ingredients: Ding Fen (Calamina), Feng Hua Hui (Weathered Ash), Ku Bai Fan (Alumen Exsiccatum, separately ground) [3 qian], Ru Xiang (Olibanum, separately ground) [0.5 qian], Mo Yao (Myrrha, separately ground) [one "zi"].
Preparation and Administration: Grind each ingredient into fine powder separately, mix evenly, and grind again. Apply externally.